Association of older age with outcomes of retrograde chronic total occlusion percutaneous coronary interventions
Toros University, Mersin, Türkiye
Department of Cardiology, Adana City Training and Research Hospital, Adana, Türkiye
Department of Cardiology, Bezmialem Vakif University, Istanbul, Türkiye
Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Türkiye
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, USA
Cardiology Department, School of Medicine, Biruni University, Istanbul, Türkiye
Introduction
The association of older age with collateral characteristics, retrograde crossing success, and procedural outcomes in chronic total occlusions-percutaneous coronary intervention (CTO-PCI) remains poorly understood.
Aim
To investigate the association between older age and collateral characteristics, retrograde crossing success, and procedural outcomes.
Material and methods
Among 2,077 CTO-PCI procedures performed between January 2019 and April 2026 at four experienced CTO centers, 564 procedures with complete datasets and at least one attempted retrograde approach were included. Procedures were stratified according to age (< 65 vs. ≥ 65 years). Collateral assessment, collateral crossing, retrograde lesion crossing, and procedural outcomes were analyzed. Inverse probability of treatment weighting (IPTW) and multivariable logistic regression analyses were performed to identify predictors of successful retrograde crossing.
Results
A total of 201 of 564 procedures (35.6%) were performed in patients aged ≥ 65 years. Elderly patients were more likely to have moderate/severe calcification (58.7% vs. 43.3%, p < 0.001), and had higher J-CTO scores (3.3 ±1.0 vs. 3.0 ±1.0, p = 0.004) and more difficult J-channel collateral anatomy (38.8% vs. 30.3%, p = 0.020). In the unadjusted analysis, successful retrograde CTO crossing was significantly lower in elderly patients (61.7% vs. 73.0%, p = 0.007). Technical success (74.6% vs. 83.7%, p = 0.009) and procedural success (73.1% vs. 82.1%, p = 0.013) were also lower in elderly patients. After IPTW adjustment, age ≥ 65 years remained independently associated with lower odds of successful retrograde crossing (OR = 0.64, 95% CI: 0.41–0.99; p = 0.039). Continuous age analysis demonstrated a progressive decrease in retrograde crossing success with increasing age (OR/year = 0.969, p = 0.001). Vascular access-site complications were more frequent in elderly patients (4.5% vs. 1.7%, p = 0.046).
Conclusions
Older age remained independently associated with lower retrograde CTO crossing success after IPTW adjustment.
Keywords
elderly patients, retrograde approach, collateral channel crossing
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